April W. Armstrong, MD, MPH, Editor-in-Chief of Dermatology Online Journal, presented a curated review of notable and high-interest articles recently published in Dermatology Online Journal and SKIN, highlighting atypical case reports and emerging therapeutic approaches for refractory dermatologic conditions. Dr Armstrong emphasized how these publications surface early clinical insights and practical lessons that can inform real-world dermatology practice.
The presentation featured several complex diagnostic cases drawn from recent publications, including a pediatric patient with painful facial ulcers initially resembling pyoderma gangrenosum who was ultimately diagnosed with granulomatosis with polyangiitis after biopsy and imaging, underscoring the importance of reconsidering diagnoses in refractory ulcerative disease. Additional cases included Parry Romberg syndrome presenting as progressive facial atrophy, with complete cutaneous resolution reported following treatment with upadacitinib. Together, these cases illustrated how uncommon diseases may present subtly and evolve over time, requiring reassessment when standard therapies fail.
Dr Armstrong also highlighted published case reports describing off-label use of targeted therapies, particularly Janus kinase inhibitors, across a range of inflammatory and immune-mediated conditions. Examples included reports of abrocitinib for localized granuloma annulare, upadacitinib for pyoderma gangrenosum and drug-induced subacute cutaneous lupus erythematosus, as well as ivermectin for childhood granulomatous periorificial dermatitis refractory to conventional therapy. Emerging topical approaches were also reviewed, including roflumilast cream for cutaneous lichen planus in patients with limited tolerance for topical corticosteroids. Collectively, these articles highlight how peer-reviewed case literature can expand therapeutic considerations for rare and treatment-resistant disease.